Thursday, March 24, 2011

Survey says … One year later, health care reform is still puzzling

One year after the health insurance overhaul bill became law, you'd think public opinion would be easy to read.

You'd be wrong.

Just before President Barack Obama signed the Patient Protection and Affordable Care Act on March 23, 2010, CBS News pollsters asked about 1,000 respondents if they believed the changes would "make the health care system better."

Twenty-eight percent answered, "don't know enough about the reforms yet to say." Last week, when CBS asked the same question, 44 percent chose that answer — a startling leap in confusion or confessed ignorance about an issue that's never left the national stovetop.

These numbers dovetail with the results of a Kaiser Family Foundation poll last month that found 22 percent of Americans believe the law has been repealed and another 26 percent aren't sure if it's been repealed.

This month, Kaiser found 53 percent of respondents describe themselves as "confused" about health care reform, up from an average of 47 percent in the organization's 10 tracking polls taken since April.

Therefore, it's unwise to make too much of a CNN/Opinion Research poll released this month that found support for the law at a historic low of 37 percent, with opposition back at 59 percent, where it was in a similar poll a year ago.

Unwise first because, as we've seen, huge percentages of the population admit they really don't understand the law. And unwise second because, when you unpack the opposition number, you find it consistently includes 13 percent who say they're against the bill because it's not liberal enough — they think it leaves too many people without coverage or at the mercies of private insurance companies.

Only 43 percent oppose the health care reforms because they're too liberal, according to CNN, while 50 percent either favor them or want them to be more liberal.

Similarly, Kaiser found 39 percent support repealing the law, 21 percent want to keep the law as is and 30 percent want to expand it.

And a Bloomberg poll taken earlier this month found 41 percent of respondents favor repeal, but 54 percent want to leave it as is or wait to see how the changes work (though only 15 percent of respondents said they knew "a lot" about the law).

A Gallup Poll survey question last week kept it simple: "All in all, do you think it is a good thing or a bad thing that Congress passed this law?"

Good thing: 46 percent. Bad thing: 44 percent.

So the idea I advanced a year ago — that, once signed, health insurance reform would quickly grow in popularity and leave the controversy behind — was clearly wrong.

But also clearly wrong was the idea that the changes were rammed down the throat of the public and that Obama and the Democrats ignored the will of the American people in enacting them. In fact, when poll takers pull apart the law and ask about its individual elements, the only provision without strong majority support is the one now being tested in the courts that requires most people to buy insurance or pay a fine.

This suggests to me that the battle for public opinion on this issue remains winnable if the Democrats can get their campaign marketing groove on and get their sound bites in order.

Meanwhile, in poring over other recent polling data, the Democrats seem to prevail when it comes to the central political quarrel in Wisconsin now spreading to other states.

In nationwide scientific surveys taken since mid-February, ABC News/Washington Post found 67 percent support collective bargaining by public employees, Bloomberg found 64 percent support, NBC News/Wall Street Journal found 77 percent and CBS/New York Times found 60 percent.

You'd think that the Republicans who whined so piteously a year ago about the need to follow the will of the people and not impose policy changes without the consent of the governed would drop these efforts out of embarrassment, if not expediency.

Drew Altman, President and CEO of the Kaiser Family Foundation, 2/24/11: "I am seldom surprised by our poll findings, but this month’s tracking poll produced a doozy. Twenty-two percent of the American people think the Affordable Care Act has been repealed, and another 26 percent aren't sure." (PBS interview on this result with Altman)

Quote this week from Republican House Speaker John Boehner: "A more fundamental promise was broken when this government takeover of health care was pushed through. That day, that week, the people said one thing, and their government did another."

March 23, 2011 Quinnipiac University Poll of Ohio voters: "Half of those surveyed were asked about a bill that limited "collective bargaining," and oppose the measure 48 - 41 percent; The other half were asked about a bill that limited "collective bargaining rights," and oppose that measure 54 - 35 percent."

Yeap. In fact, did you know that Currently, many insurance companies do not allow adult children to remain on their parents' plan once they reach 19. Companies cannot do that any more. Search onilne for "Wise Medical Insurance" and you can insure your kids if you are in the same boat.

These surveys miss the point. How about measuring the level based on who is paying the bills. People will never vote against a benefit that they do not have to pay for. I am all for providing insurance for the uninsured as long as I don't have to pay for it... But who will pay?

--People don't understand that they are already paying for the uninsured, through higher medical costs. Somebody has to pay for those bills when someone goes bankrupt, not to mention the low & no-income people who end up in the ER.

The response “Do not know enough…to say” does not necessarily indicate that respondents are uninformed – it may, in fact, mean that individuals are paying attention as the results of the law unfold.

Remaining consistent, individual components of the law test well. (Do you like tropical vacations? YES – WHEN DO WE PACK?) When costs begin to become apparent (Okay, fork over $10,000), people may experience some conflicted (or confused) feelings (OH – I HAVE TO PAY??).

Informed citizens have watched as insurance premiums rise; as selected businesses, labor unions, and local governments receive waivers from the requirements of the law; as economic recovery remains slow (perhaps employers are resistant to paying for the new higher-cost employees and their 26-year old children?); and as the medical cost curve continues to go up. Oh – and can individuals keep their lower-cost, health savings accounts if they choose?

WE MUST REMEMBER that very important legislation, such as healthcare reform, is almost ALWAYS passed being in need of even major modifications, and that passage in almost any form is a significant achievement. All the squabbling is related to commercial entities opportunities for benefit and loss, not to that of our citizens who can hardly lose given the present state of the system.

"WE MUST REMEMBER that very important legislation, such as healthcare reform, is almost ALWAYS passed being in need of even major modifications, and that passage in almost any form is a significant achievement."

Right. That is why all of Obama's buddies are asking for waivers so that they can opt out of Obamacare.

So Eric, since you state that the Republicans should go along with "the will of the people" how do you justify the massive income tax increase, which Pat Quinn claimed he had a "mandate" given that over 53% of the voters voted AGAINST him?

ZORN REPLY -- I've never made the argument that legislators should take plebiscites before they vote. That was the GOP argument a year ago. It's about hypocrisy.

All of these tactics to spin opposition to the health care program has already been done by the oil, beverage and banking businesses. The "playmakers" book was created by the tobacco industry and is followed by spin masters against health care change. Distract people from the real problem; generate fear ; split communities with rhetoric, pitting one against anothern, and say one thing in public and another in private. Spin will always exist but hopefully people will look into facts not opion lead media that only scratch the surface of these important subjects.Always look behind these issues to see how your emotions are being manipulated . You can bet they are.

[[But also clearly wrong was the idea that the changes were rammed down the throat of the public and that Obama and the Democrats ignored the will of the American people in enacting them. In fact, when poll takers pull apart the law and ask about its individual elements, the only provision without strong majority support is the one now being tested in the courts that requires most people to buy insurance or pay a fine.]]

I am puzzled as to how you reach the conclusion that the idea the bill was rammed down our throats is "clearly wrong." I am guessing, it's because when poll takers pulled apart the law people liked it? Are you talking about then or now?

We will disagree on this, but I have always found "ramming" appropriate. There was a reason that bill got pushed through before the recess and that was because Obama and company knew as soon as legislators got home and heard from constituents lawmakers would get cold feet. There was a reason they went "reconciliation," to avoid the filibuster. That bill was written on the fly, with sections added and discarded as sweeteners to various wavering lawmakers were added and discarded. Kucinith? Hey, he got a ride on Air Force One and voila! HIs vote changed! (I('d forgotten about that until I saw a reference to it this week.) Maine senator goes yes and suddenly, Obama and family visit Maine a few months later! Don't get me started on the Cornhusker kickback.

There are the 1,000-plus waivers from the law, including one for the entire state of Maine. NYC wants one too! Report after report indicates the bill will cost vastly more than ever scored by the CBO, which is required to accept as fact every rosy, unrealistic provision written into it.

We were fed a line of baloney. A majority of us recognized it and protested. The baloney (balogna) was force fed to us anyway.

I do give you credit for saying you were clearly wrong about the bill being popular after we found out its virtues (and vices). There IS a reason the Democrats got the "shellacking" they did in November, you know. Well, there are reasons. Health care "reform" was one of them.

Our rates, by the way, went up nearly 18 percent. Fully half was attributable to Obamacare.

Sorry, but I'm calling shenanigans on your "fully half was attributable to Obamacare". In a past life I was an insurance underwriter and while I did not underwrite medical insurance (I underwrote life, dental, and disability insurance) I know for a fact that the one thing that affects rates the most is actual claim experience for the person/group being insured. Insurance companies almost always base their rates on what their expected claim cost is (based on PAST experience) plus some extra amount on top for margin and expenses. Legislation does not play a part in rating insurance contracts and I challenge you to show everyone proof that "half" of your increase was attributable to the Affordable Health Care Act.

As for your "shellacking" comment, you may be happy that November 2010 went relatively well for Republicans, however the mere fact that the Democrats are still in charge of the Senate when the GOP could have taken that as well should tell you that you aren't as "right" as you think you are. I'm not sure why you conservatives are falling on your sword to protect the system we currently have in place. Our current system is FAR more similar to socialized medicine than what you're fighting against. Just who do you think is paying for all of the uninsured patients who are showing up at the hospital now? At least with reform it's forcing people to pay for their own cost of insurance (when they can) instead of having it spread out amongst those of us who are responsible enough to have insurance. I think it's funny that conservatives were the ones calling liberals "socialists" because of health care reform when they didn't even realize the irony.

One day conservatives will wise up and stop listening to the nut jobs that they've hitched their wagon to. When they do, I'll be back to voting for Republicans.

The Republicans will fail because their only message going forward is to make massive cuts to or eliminate programs and causes most of the American people support. Saying that eliminating Obamacare and bargaining rights for workers will save jobs is a lie only their Tea Party supporters believe. Instead this will result in massive job cuts, reduction in pay and benefits for the middle class, and higher expenses for all. Running on cutting the deficit while protecting tax cuts for the wealthy is also a losing message. The last futile attempt to deny rights for gays and women is also a non-starter. Basically, they have nothing positive to offer the American people.

" Our current system is FAR more similar to socialized medicine than what you're fighting against."

Bull! Doctors are on their way to becoming government employees. The old model of 2 or 3 doctors in a neighborhood practice will soon go the way of horses and buggies. We are moving toward a model where you go to the Department of Medicine and take a number.

" Running on cutting the deficit while protecting tax cuts for the wealthy is also a losing message."

Define "tax cuts for the wealthy." Point to a bill that was passed during the Bush Administration that singled out the the wealthy for income tax cuts. The liberals have been telling this lie so many times that they have begun to believe it themselves.

Brian -- I can only repeat what employees were told: half the increase was due to claims, half to the new provisions (you can't cover preventative care for free, you can't cover more people for free, just to give two examples, without costs going up). That's what the word from the powers that be were. And Republicans (which, by and large I'm not one, by the way; I just have never been blinded by the Obama light -- I wrote in Hillary in the '08 election, instead of voting for McCain and company) were probably never going to take back the Senate in '10. In '12? I bet they do.

I think it's relatively clear the new law is a mess. Vastly fewer people have signed up for the exchanges and risk pools. VASTLY (like a mere fraction, which I cannot recall right now). Savings are still predicated on a wing and a prayer and a wish. Come a few years from now, if this mess isn't ruled unconstitutional, we'll have sharply curtailed benefits and sharply increased prices.

Wow, intelligent response. I say "Bull!" right back to you. Where do you live that there's some neighborhood practice with two or three doctors? They don't exist anymore because health care providers have been consolidating for years...not because of "ObamaCare". You then go on to rail about liberals telling lies in your next post...conservatives have been lying about a "Department of Medicine" for about as long! Please show me anywhere in the Affordable Healthcare Act that creates a "Department of Medicine" or that actually has the government taking over ANY part of health care at all. You can't, because there isn't one, yet you conservatives have been whining about a government takeover of health care all along.

At least with the tax cuts there's a grain of truth to it. Yes, you're correct that the Bush tax cuts did not mention cuts for just the wealthy. They were for everybody. But the GOP was not going to extend tax cuts for anyone if the wealthy did not get them as well, so basically it does boil down to tax cuts for the wealthy.

Why is it that so many conservative positions require hypocrisy or blind disregard for facts?

@ Jimmy G.- "Point to a bill that was passed during the Bush Administration that singled out the the wealthy for income tax cuts."

The Bush tax cuts gave larger percentage cuts to the highest tax bracket. People with incomes over $373,650 got a 4.6% cut. The rest got 3%, unless you want to count the 'lucky duckies' who got a whopping 5% break on their
measly $16,750 incomes.

Capital Gains taxes, which primarily are paid by the more wealthy, dropped 20% for the highest bracket. Guess how executives & Wall Street types get the bulk of their compensation: stock options.

So, while the wealthy weren't 'singled out', they received a much bigger break than the middle class.

You can have obamacare - I'm going with the illegal alien plan. Just show up at emergency rooms without any identification and demand treatment. By law they have to so why should I have to pay for insurance when ILLEGALS get their treatment for free. Why do illegals have more rights and benefits than citizens in this country.
obamacare is a joke, zorn is just a pawn of democrats,
like most media nowadays - Thank GOD for FOX!

"Where do you live that there's some neighborhood practice with two or three doctors? They don't exist anymore because health care providers have been consolidating for years...not because of 'ObamaCare'."

Actually, the doctors have been consolidating because the shyster lawyers who finance the Democratic Party have driven malpractice insurance premiums so high. The liberals made sure that tort reform was NOT part of Obamacare.

"Asked by an audience member why the legislation does nothing to cap medical malpractice class-action lawsuits against doctors and medical institutions (aka 'Tort reform'), (Howard) Dean responded by saying: “The reason tort reform is not in the [health care] bill is because the people who wrote it did not want to take on the trial lawyers in addition to everybody else they were taking on. And that’s the plain and simple truth,”"

"The Bush tax cuts gave larger percentage cuts to the highest tax bracket. People with incomes over $373,650 got a 4.6% cut. The rest got 3%, unless you want to count the 'lucky duckies' who got a whopping 5% break on their
measly $16,750 incomes."

The wealthy obviously get more of a cut when tax rates are reduced because they PAY more. What part of that concept do you not understand? That does not mean that the cuts were only for the wealthy. And very few people who make a "measly $16,750" pay any income tax.

@unclejoe - You state "Capital Gains taxes, which primarily are paid by the more wealthy, dropped 20% for the highest bracket. Guess how executives & Wall Street types get the bulk of their compensation: stock options." Capital gains taxes are primarly paid by the wealthy? You do realize that mutual funds pay capital gains taxes, and that most pensions and 401k funds are made up of mutual fund investments. So lower capital gains taxes mean a better return on your 401k and pension plans.

" if the Democrats can get their Campaign marketing grooves on and get their sound bites in order"
First they have to read Obamacare and learn what's in it!! Those seeking and receiving waivers are the ones whom we know have read it through.

The reason so many people don't understand it, is because most of what is in the media comes from politicians or pundits from one side of the aisle or the other. Unbiased analysis is lost in the din. And who knows what's buried in the fine print, that rewarded those votes that were on the fence?

I've always wondered why the insurance companies are so against the government pool, when those that would use it, can't get affordable, if any, coverage on the open market, in the first place.

I'm not buying into anything any survey says until there is evidence the survey is mathematically reliable in terms of its standard deviation and was not done merely to a) support a point of view or b) generate news.

"You'd think that the Republicans who whined so piteously a year ago about the need to follow the will of the people and not impose policy changes without the consent of the governed would drop these efforts out of embarrassment, if not expediency."

Let's get some perspective here. The Democrats won the 2008 election and took control of Congress and the presidency. Good for them. That gave them the power to pass legislation that they wanted without needing any Republican help, and on the health care issue that's what they did (barely). That's the legislative process and the Republicans have to live with it. Fine. However, there is also the political battle and Republicans saw that there was resistance to the overall plan and they capitalized on it. That's fine too.

Now fast forward to 2011. Wisconsin Republicans did something similar with the public employee battle as Obama did with health care in 2008. That's the way it goes. The Democrats are capitalizing on public dissatisfaction just as the Republicans did on ObamaCare. No problem there.

The point of all this is that both Obama and Walker did what they think is right and the other side went after them for it and made sure that they will pay a political price if it goes wrong. Guess what? That's politics! Bold political moves have consequences. Those consequences can be very good if it works out and very bad if it doesn't. It's the concept of high risk / high reward.

My bet is that the health care controversy ends up being a bigger deal nationally than the public employee controversy ends up being in Wisconsin. Regardless, I don't see what the big deal is about the messaging war.

"The 3 percent of tax returns with adjusted
gross income exceeding $200,000 reported 31 percent of
AGI and 83 percent of capital gains. The 0.3 percent of
returns with AGI exceeding $1 million reported 15 percent
of AGI and 61 percent of capital gains. Capital gains
represented less than 4 percent of AGI for gains recipients
with income less than $200,000, but about 40 percent of
AGI for those with income exceeding $1 million."

It also stated that capital gains represented less then 3.5% of the AGI of taxpayers making less than $200,000 and was 13% for taxpayers between 200,000 and 1,000,000 and was 39% for taxpayers 1,000,000 and higher.

So in summary, the well off pay well more in capital gains and the capital gains is a much higher percentage of their income than the middle class does.

@Kurt - That is true, however, those numbers are just looking at individual returns. No one breaks out what percentage of capital gains are paid by group tax plans, like mutual funds or 401k's. In addition, the tax policy center doesn't break out short term and long term gains. The cuts are only on long term gains, while short term gains are still taxed as ordinary income.

What do current polls mean when much of what makes up Obamacare has yet to be written by gov't agencies that have yet to be formed. And the significant elements of the bill don't start to kick in until 2014 and later.

The big lie behind Obamacare has always been that you can insure 35 to 40 million more people and, by magic, the costs will go down and the overall care will improve. The granting of over 1,000 waivers(and growing) to “protect” people from the effects of the bill is an excellent example is the severity of the train wreck that is coming our way.

As for polling, the only one that counts occurs on election day....and last Nov was a very good start....at least on a national level.

Eric--I conducted a little survey of my own. Shockingly, MOST of my respondents, regardless of whether Dem, Repub or independent, believed there was STILL a government run plan in the bill that passed, when there is NO PUBLIC OPTION. They also believed Congress' health plan remains the same under the bill, when Congress LOSES their present health care plan in 2014 and must buy insurance from the SAME STATE EXCHANGES as their uninsured constituents. Many hadn't even heard about the state exchanges. Maybe it's time for a Zorn survey!

Dear Mr. Zorn: A French economist once observed, "Government is the great fiction through which everyone endeavors to live at the expense of everyone else." I'd like to see a poll conducted on whether or not voters agree with that cynical characterization of government. The manner in which Obamacare was passed fed right into that cynicism. It was a quite a legislative circus to behold. Ringmaster Pelosi famously said, "You have to pass the bill before you can know what's in the bill." More realistically than Speaker Pelosi, I believe that voters were and still are able to connect these two dots: One, Obamacare promises a lot in looking to cover millions who were uninsured, and, ... well, two, where will the money come from to pay for the health care when the government is already broke? Then there is this: Most of us agree that the fact that so many Americans go without health insurance is something we need to address. However, the basic point of departure in the debate is that many Americans don't think that the fix requires us to take a sledge hammer to 1/7 of our market economy represented by the healthcare industry.

Obamacare was based on a completely unsubstantiated assumption as its foundation. The legislation focused on insurance reform, but left untouched any payment reform. I suspect that this reflected and still reflects a the Democrats' lack of understanding the of what can and should be the optimal roles of government and of market competition in healthcare. Obamacare did nothing to the bend the health care cost curve. "Bending the cost curve" requires us to reform, not the way we are insured, but the way we pay providers. We may not yet know the best way to do this, but we know the fundamental thing that must be done: End fee-for-service medicine. Providers must be paid in a way that rewards good care, not more care. The most straightforward way to do this is to pay providers with a salary, allowing bonuses based on quality measures, but not on incentives to do more or to do less. Promoting competition among insurers also does nothing to promote competition among providers that we need to lower costs and might wish to increase innovation.

To cover their tracks as far as demonstrating the cost effectiveness of Obamacare, Democrats relied on that tried and true method of demonstrating the soundness of their legislation by calling upon the CBO to "score" this sorry piece of legislation. In Washington, the game that is played with the CBO by both Democrats and Republicans involves straight jacketing the CBO with assumptions on which it must base its reports. By causing the CBO to be hamstrung and limited in this way, the CBO is only able to produce estimates based on the scenarios provided to it by the majority party that aims to promote its legislation as a genuine cost cutting measure, no matter off base the assumptions for the scenarios may be. The most egregious assumption used for Obamacare in the CBO report was the assumption that doctors fees for Medicare could be cut by $450 billion. Though it's labeled an assumption, it so distorts the CBO report that it's quite right for some of us ignorant voters to call it an outright lie. Medicare patients are being turned away by more and more doctors who refuse to accept the fee schedule already used by Medicare. And the Democrats think that another $450 billion in fee reductions against doctors is possible?

We have to control health care spending, but no Democrat who voted for Obamacare has been willing to admit the cold, hard truth. We can force insurers and employers to offer more and more healthcare benefits while thinking we can hold down increases in premiums through our new healthcare commissar, Kathleen Sebilius. It is she who has the Soviet style of power to determine how much is too much when it comes to premiums under Obamacare. If the government squeezes too hard, who doubts that we will end up with single payer in the form of the government acting as the health care provider. If we end up with single payer in the form of the government acting as the health care provider, then doctors and hospitals will become defacto employees and assets of the state. Despite what some of you on the left may think, doctors are free to quit and, human nature being what it is, we can expect that far fewer of our brightest students will turn to medicine as a career if government calls all the shots on how much doctors can earn. When doctors' salaries become the topic of budget debates in Congress, how skilled do you think your own surgeon will be 10 or 20 years or so after single payer arrives? Or is altruism a virtue that is so prevelant in medicine that we might expect doctors to work for far less than they are paid now?

Even after single payer comes to pass with a clamp down on doctors' salaries and fees by government, spending will have to be controlled by some form of rationing. Yes, Virginia, there is a limit as to how much you can tax people to pay for it all and to pay for all other government entitlements, national defense, and interest on the national debt. Rationing means that that benefits will be denied according to a schedule of benefits issued by the single payer, the state, instead of an insurance company. But, trust me, rationing (denial of benefits) will never leave us.

--I'm still waiting for the Republicans that I voted for to put and end to this law that redistributes my money to lazy unproductive welfare recipients. The Tea Party will need to find better candidates in 2012 that really don't care about getting re-elected. Quinn must go as he is sickly and can't stand up to a union. IL is ILL.

About "Change of Subject."

"Change of Subject" by Chicago Tribune op-ed columnist Eric Zorn contains observations, reports, tips, referrals and tirades, though not necessarily in that order. Links will tend to expire, so seize the day. For an archive of Zorn's latest Tribune columns click here. An explanation of the title of this blog is here. If you have other questions, suggestions or comments, send e-mail to ericzorn at gmail.com.
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Contributing editor Jessica Reynolds is a 2012 graduate of Loyola University Chicago and is the coordinator of the Tribune's editorial board. She can be reached at jreynolds at tribune.com.